-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, NMscXje/PoYdknFWLXxCr+IucThCUs2oaHJsjMl+9EvIK5A0iWEz/AHjG35XboAI r3Z3zOtKVsBSgBIX96fvSQ== 0000895813-98-000161.txt : 19980702 0000895813-98-000161.hdr.sgml : 19980702 ACCESSION NUMBER: 0000895813-98-000161 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19980630 FILED AS OF DATE: 19980701 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: AMERICAN COUNTRY HOLDINGS INC CENTRAL INDEX KEY: 0000315411 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 060995978 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-22922 FILM NUMBER: 98658997 BUSINESS ADDRESS: STREET 1: 222 N LASALLE STREET STREET 2: C/O JOHN DE ELORZA CITY: CHICAGO STATE: IL ZIP: 60601-1105 BUSINESS PHONE: 3124562000 MAIL ADDRESS: STREET 1: 222 N LASALLE STREET CITY: CHICAGO STATE: IL ZIP: 60601-1105 FORMER COMPANY: FORMER CONFORMED NAME: WESTERN SYSTEMS CORP DATE OF NAME CHANGE: 19970326 FORMER COMPANY: FORMER CONFORMED NAME: WESTERN TRANSMEDIA CO INC DATE OF NAME CHANGE: 19920703 FORMER COMPANY: FORMER CONFORMED NAME: VIGILANCE SYSTEMS CORP DATE OF NAME CHANGE: 19920202 COMPANY DATA: COMPANY CONFORMED NAME: SOLOMON MARTIN L CENTRAL INDEX KEY: 0001012912 STANDARD INDUSTRIAL CLASSIFICATION: UNKNOWN SIC - 0000 [0000] DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: P O BOX 70 CITY: COCONUT GROVE STATE: FL ZIP: 33133 BUSINESS PHONE: 3058563103 MAIL ADDRESS: STREET 1: P O BOC 70 CITY: COCONUT GROVE STATE: FL ZIP: 33133 4 1 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ( ) Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instructions 1(b). 1. Name and Address of Reporting Person: Martin L. Solomon P.O. Box 70 Coconut Grove, Florida 33233 U.S.A. 2. Issuer Name and Ticker or Trading Symbol: American Country Holdings Inc. ACHI ACHW 3. IRS or Social Security Number of Reporting Person (Voluntary): ###-##-#### 4. Statement for Month/Year: June 1998 5. If Amendment, Date of Original (Month/Year): August 1997 6. Relationship of Reporting Person(s) to Issuer (Check all applicable): (x) Director (x) 10% Owner (x) Officer (give title below) ( ) Other (specify below) President, Chief Executive Officer 7. Individual or Joint/Group Filing (Check Applicable Line): (x) Form filed by One Reporting Person ( ) Form filed by More than One Reporting Person
Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 5. Amount of 6. Owner- Securities ship Form: 7. Nature of 2. Transaction Beneficially Direct (D) Indirect 1. Title of Date 3. Transaction 4. Securities Acquired Owned at or Indirect Beneficial Security (Month/ Code (A) or Disposed of (D) End of Month (I) Ownership (Instr. 3) Day/Year) (Instr. 8) (Instr. 3, 4 & 5) (Instr. 3 & 4) (Instr. 4) (Instr. 4) ------------ -------------- -------------- ---------------------- -------------- ------------ ------------ Code V Amount (A)or(D) Price Common Stock, 6/10/98 P 10,000 A $1.75 8,028,043 D $.01 par value Common Stock, 6/15/98 P 13,300 A $1.6875 8,041,343 D $.01 par value Common Stock, 6/29/98 P 9,000 A $1.6875 8,050,343 D $.01 par value /TABLE
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 9. Number 10. Owner- 5. Number of ship of Deriva- Deriva- Form of tive tive Deriva- 2. Conver- Securities Securities tive 1. Title sion or Acquired 6. Date 7. Title 8. Price Benefi- Security: of Exercise 3. Trans- (A) or Exercisable and of cially Direct 11. Nature Deriva- Price of action 4. Trans- Disposed and Amount of Deriva- Owned at (D) or of Indirect tive Deriva- Date action of (D) Expiration Underlying tive End of Indirect Beneficial Security tive (Month/ Code (Instr. 3, Date(Month/ Securities Security Month (I) Ownership (Instr. 3) Security Day/Year) (Instr. 8) 4 & 5) Day/Year) (Instr. 3 & 4) (Instr. 5) (Instr. 4) (Instr. 4) (Instr. 4) ---------- -------- --------- ---------- ---------- ------------- --------------- ---------- ---------- ---------- ----------- Code V (A) (D) Date Expir- Title Amount or Exer- ation Number of cisable Date Shares Redeemable $1.83 6/2/98 P 8,000(A) Exercisable: Common Stock - $0.50 22,705 D Common Stock At any time 17,520 Purchase Expiration: Warrants 8/31/98
Explanation of Responses: SIGNATURE OF REPORTING PERSON: /s/ Martin L. Solomon ============================== -----END PRIVACY-ENHANCED MESSAGE-----